Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kathleen Yancey, RD, PA

Individual provider Registered Dietitian · NPI 1053087114

Kathleen Yancey, RD, PA is a Physician Assistant in Orange Park, Florida. Qualified in 2021, 5 years ago. Practices with Park Avenue Dermatology PA, a 13-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
5
Licensed in
FL
In the registry since
2021
Specialties on file
2
What do these letters mean?
RD — Registered Dietitian
A credentialed nutrition professional.
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

906 Park Ave
Orange Park, FL 32073-4120
Phone: (904) 541-0315
Fax: (904) 541-0316
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 929 Ironridge Ct, Orange Park, FL 32065-5747 — (904) 614-0670

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9115044 (FL)
Registered Dietitian Taxonomy 133V00000X · Licence ND7019 (FL)

Record details

NPI number1053087114
Entity typeIndividual (Type 1)
GenderFemale
Credentials RD , PA
Sole proprietorNo
NPI enumeratedAugust 19, 2021
Last updated in NPPESNovember 8, 2021
Certification dateNovember 8, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Park Avenue Dermatology Pa — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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